Psychiatrists move to redefine mental disorders

Be prepared, there’s soon to be a new doctor’s dictionary released, and many of the old terms to describe mental illnesses are redefined. One is no longer “mentally retarded”, they now have an “intellectual disability.” There’s no more diagnoses of Asperger’s syndrome – call it a mild version of autism instead. Newly added are “behavioral addictions.” Internet addiction never made the cut.

Today the American Psychiatric Association is proposing new changes to its diagnostic bible. This is the manual that doctors, insurers and scientists use in deciding what’s officially a mental disorder and which symptoms to treat. In a new twist, it is seeking feedback via the Internet from psychiatrists and the public about whether the changes will help.

The manual now includes many new diagnoses. Gambling is now a behavioral addiction, while learning disabilities are problems with both reading and math. Also new is binge eating, distinct from bulimia because the binge eaters don’t purge.

The draft also proposes diagnosing people as being at high risk of developing some serious mental disorders – such as dementia or schizophrenia – based on early symptoms, even though there’s no way to know who will worsen into full-blown illness.

The psychiatrist group’s own leaders say, it’s a much needed category, so they don’t miss someone along the way who needs counselling…the drafts also sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

Now the draft’s biggest changes will eliminate diagnoses that it contends are essentially subtypes of broader illnesses – and urge doctors to concentrate more on the severity of their patients’ symptoms. A new category alone titled: Autism Spectrum Disorders as the diagnosis that encompasses a full range of autistic brain conditions – from mild social impairment to more severe autism’s lack of eye contact, repetitive behavior and poor communication – instead of differentiating between autism, Asperger’s or “pervasive developmental disorder” as doctors do today.

Psychiatrists think this new categorization will lower the numbers of people actually diagnosed mentally ill.

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In the autism world, “Aspies” are sometimes seen as the elites, the ones who are socially awkward, yet academically gifted and who embrace their quirkiness.

Now, many Aspies, a nickname for people with Asperger’s syndrome, are upset over a proposal they see as an attack on their identity. Under proposed changes to the most widely used diagnostic manual of mental illness, Asperger’s syndrome would no longer be a separate diagnosis.

Instead, Asperger’s and other forms of autism would be lumped together in a single “autism spectrum disorders” category. Some parents say they’d welcome the change, thinking it would eliminate confusion over autism’s variations and perhaps lead to better educational services for affected kids.

Liane Holliday Willey, a Michigan author and self-described Aspie whose daughter also has Asperger’s, fears Asperger’s kids will be stigmatized by the autism label — or will go undiagnosed and get no services at all.

Grouping Aspies with people “who have language delays, need more self-care and have lower IQs, how in the world are we going to rise to what we can do?” Willey said.

Rebecca Rubinstein, 23, a graduate student from Massapequa, N.Y., says she “vehemently” opposes the proposal and will think of herself as someone with Asperger’s no matter what.

Autism and Asperger’s “mean such different things,” she said.

Yes and no.

Both are classified as neurodevelopmental disorders. Autism has long been considered a disorder that can range from mild to severe. Asperger’s symptoms can vary, but the condition is generally thought of as a mild form and since 1994 has had a separate category in psychiatrists’ diagnostic manual. Both autism and Asperger’s involve poor social skills, repetitive behavior or interests, and problems communicating. But unlike classic autism, Asperger’s does not typically involve delays in mental development or speech.

The American Psychiatric Association’s proposed revisions, announced Wednesday, involve autism and several other conditions. The suggested autism changes are based on research advances since 1994 showing little difference between mild autism and Asperger’s. Evidence also suggests that doctors use the term loosely and disagree on what it means, according to psychiatrists urging the revisions.

A new autism spectrum category recognizes that “the symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders,” said Dr. Edwin Cook, a University of Illinois at Chicago autism researcher and member of the APA work group proposing the changes.

The proposed revisions are posted online at http://www.DSM5.org for public comment, which will influence whether they are adopted. Publication of the updated manual is planned for May 2013.

“It would be just like if you were a student at MIT. You might not want to be lumped with somebody in the community college,” said Dulcan who supports the diagnostic change.

“One of the characteristics of people with Asperger’s is that they’re very resistant to change,” Dulcan added. The change “makes scientific sense. I’m sorry if it hurts people’s feelings,” she said.

Harold Doherty, a New Brunswick lawyer whose 13-year-old son has severe autism, opposes the proposed change for a different reason. He says the public perception of autism is skewed by success stories — the high-functioning “brainiac” kids who thrive despite their disability.

Doherty says people don’t want to think about children like his son, Conor, who will never be able to function on his own. The revision would only skew the perception further, leading doctors and researchers to focus more on mild forms, he said.

It’s not clear whether the change would affect autistic kids’ access to special services.

But Kelli Gibson of Battle Creek, Mich., whose four sons have different forms of autism, thinks it would. She says the revision could make services now designated just for kids with an “autism” diagnosis available to less severely affected kids — including those with Asperger’s and a variation called pervasive developmental disorder-not otherwise specified.

Also, Gibson said, she’d no longer have to use four different terms to describe her boys.

“Hallelujah! Let’s just put them all in the same category and be done with it,” Gibson said.

Unlike in conventional medicine where objective diagnoses and treatments are made based on observable biological evidence, psychiatrists get together every so often to decide what should or should not be considered a “mental illness.” And they do not always agree, as evidenced by the more than 13,000 professionals from around the world who recently signed an open letter demanding that the upcoming edition of the psychiatry industry’s “diagnostic manual” be put on hold and reconsidered.